Richard Smith: The cleansing power of the “perfect” death

If you’ve not seen “Blackbird,” a film that is now available on Amazon Prime, and plan to, then read no further.

When I give talks on death I ask the audience to chose among the four types of death—sudden, long and slow from dementia and frailty, up and down from organ failure, and slow then fast from cancer—and almost everybody choses sudden death. I then say that if that’s the death you’d like you must be sure that all of your important relationships are in good working order—otherwise, you may create a huge burden of grief.

I don’t offer the audience the option of suicide or assisted dying, but perhaps in the future I should. The film Blackbird, which we watched last night, showed how assisted dying might combine the neatness of sudden death with a chance to put all relationships right.

The film starts in a lovely seaside home with the husband looking at the sea and his partially-paralysed wife struggling out of bed. Their daughter, her husband, and grandson arrive. The daughter is neurotic and controlling, the husband dull and inhibited, and the grandson squashed. Everything is awkward. Then another younger daughter arrives with her husband, and we see at once that she is troubled and her relationship with the family fraught. The best friend of the partially-paralysed woman also arrives. The scene is set.

They have a jolly dinner and play charades. All seems well. We learn early the next morning that the partially-paralysed woman plans to kill herself at the end of the weekend. Otherwise, she faces the prospect of increasing paralysis, being unable to swallow, and being fed through a tube. As assisted suicide is illegal in this state, her husband, a doctor, will be with her when she drinks the potion they have ordered through the internet, go out for a walk, return, and call 911, saying his wife must have taken the potion. He faces the prospect of a trial and imprisonment. We learn too that people who opt for assisted dying are largely well-educated, intelligent, articulate, and “very controlling.” Data from Canada shows that the first three qualities are true, but I’m less sure about the fourth.

At the Saturday breakfast the partially-paralysed wife says she wants to have Christmas that summer’s day, her last full day. She allocates duties. The mood is strained, but perhaps not as strained as it might be were this not fiction. At this point we learn that the troubled daughter plans to ring 911 when her mother is attempting suicide: “She may be ready to die, but I’m not ready.” Only her husband knows of this plan.

Now the revelations, the cleansing, begins. The grandson tells his grandmother what he has never told anybody—that he’d like to become an actor. At the Christmas dinner he has the courage to tell his parents. Later, at the end of the excellent dinner, a bottle of Gevrey-Chambertin, and a joint of strong dope the partially-paralysed wife tells everybody how content she is to have the people she loves around her and how ready she is to die. At this point the troubled daughter says that her mother knows nothing about her and how she recently tried to kill herself and was in a mental hospital for three months. She rushes out. Her husband tells the controlling daughter what her wife proposes, and there is a scene.

Later that night the controlling daughter sees her father kissing his wife’s best friend. She’s horribly distressed and spends the night drinking and looking at old photo albums, realising that the best friend has been with them on all their family holidays. Has this been a life-long affair? Should she tell her mother?

Eventually in a climactic scene on the Sunday morning the troubled daughter promises not to phone 911, the controlling daughter tells her mother of her husband’s affair, and her mother says that she knows—indeed, has set up the relationship to fill the hole she will leave. Everything is out in the open. Everybody is reconciled. The partially-paralysed mother says “It’s time.” In the next scene she is in bed with her daughters snugging her from either side, and her husband hands her the potion. She hesitates, then drinks it. “I’m scared,” she says as she goes unconscious.

This is fiction, a fiction that doesn’t always convince, but it does illustrate to me how those who want a sudden death, the majority, might be able through assisted dying to combine the neatness of a sudden death with being sure that all important relationships are in good shape. I would advise, however, not leaving it to a final weekend.

I must add a footnote. Humans, including me, have a tendency to romanticise death. The true romantic is concerned primarily with love and death and is always most in love with somebody who is dead, far away, or a fantasy, a fairy. In this way love is not sullied with everydayness. And just as love can be sullied death can be ghastly, breathless, painful, and messy. It often is. It is not easily controlled, but assisted dying offers the prospect of control. Is the offer to be accepted? It does seem to be in countries where it is legalised: once legalised, assisted dying has not so far been recriminalised.

Richard Smith was the editor of The BMJ until 2004.

Competing interests: RS is the unpaid chair of the Lancet Commission on the Value of Death.